Rotator Cuff Strain Rehabilitation Program 2016-11-01T18:08:37+00:00

How to Use the Rotator Cuff Strain Program

Always consult your physician or physical therapist before beginning any exercise program. The information is not intended to diagnose or treat any medical condition. If you experience pain or difficulty with these exercises, stop and consult your healthcare provider. Your use of this program indicates your assumption of the risk of injury and is an acknowledgment of your own sole responsibility for your safety training for climbing. The developer of this program and all associated third parties assume no liability for injuries sustained by participants who engage in any aspect of this program.

“Editor Note Insert How to Video”

Phases

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Phase 1. Pain, Inflammation and Tissue Overload:  This phase is at the base of the rehabilitation pyramid. It is typically the stage when you first realize you are injured. Oftentimes you will ignore the pain, inflammation and overuse until you can no longer climb. The longer you stay in this level without addressing your injury, the further you will damage your tissues and the more challenging it becomes to fully recover. The goal of this phase is to decrease pain, inflammation and tissue damage.

Phase 2. Mobility: Over the past 10 years, abundant research has surfaced about the importance of moving injured tissues and not to immobilize them. The increased circulation, range of motion and muscle activity that is gained through movement can aid in the healing process. This program follows an active rehabilitation approach that places an emphasis on using movement to heal. This is why there are no recommendations for immobilization devices in this program. However, movement isn’t the answer for some injuries. Examples of injuries that need immobilization are fractures, high-grade sprains/strains and dislocations. Always seek advice from your medical professional if you are unsure if it is safe for you to move and perform exercises in this category. The goal of this phase it to promote healing of the injured area, increase circulation and restore normal range of motion

Phase 3. Strength: Muscle strength is key in the process of rehabilitating injury. There are three primary forms of muscle contraction. Concentric, eccentric and isometric. Each type of muscle contraction has its benefits and each is used for different exercises in the book and while climbing. Each strength exercise in the book will clearly indicate in the instructions whether to perform concentrically, eccentrically or isometrically. The goal of this phase is to improve neuromuscular control, improve isolated strength and improve functional strength.

Phase 4. Movement: This is the most important rehabilitation category. You can have complete range of motion and full strength but if you return to climbing without changing poor movement patterns you are prone to re-injury. Climbing technique involves repetitive movement patterns. Over time, repetitive movements can lead to wear and tear of the tissue in the body. Specific movement patterns are correlated to specific tissue stresses. Each injury in this book has three associated movements that can lead to the specific injury and three ways to correct them. It is up to you to identify which of these movement patterns you routinely overuse climbing. The goals of this phase are to reinforce proper movement patterns, initiate the return back to higher level climbing and eventually to promote tge concept of performing the rehabilitation program as an injury prevention program twice a week.

Levels

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The mobility and strength phases are each broken into three levels. This means that each exercise level is progressively more challenging than the previous. This allows you to improve your mobility and strength in a stepwise manner. Follow the Rehabilitation Pyramid Rules to know when to progress to the next level. You will give each rehabilitation workout a score between 1 and 4 based on how much pain/soreness that you had during and after. The score you give will judge whether or not you will progress to the next level. Use the Rehabilitation Pyramid Rules below to learn about this scoring system.

Rehabilitation Pyramid Rules

Scoring Criteria (1-4) Progression
1. Constant soreness/pain greater than 3/10 that worsens with warm-up, light climbing or mobility exercise level 1. Perform unloading technique for two weeks. Resume warm-up, light climbing or mobility exercise level 1 when soreness/pain decreases to less than 3/10. If no decrease in the constant soreness/pain level, see a medical professional.
2. Intermittent soreness/pain less than 3/10 that does not change while performing warm-up, light climbing or rehabilitation exercises but increases the next day. Perform unloading technique as needed.

Stay at current level.

3. Intermittent soreness/pain less than 3/10 that does not change while performing warm-up, light climbing or rehabilitation exercises and does not increase the next day. Perform unloading technique as needed.

*Advance one level per week or as instructed by healthcare professional.

4. Intermittent soreness/pain less than 3/10 that improves while performing warm-up, light climbing or rehabilitation exercises and does not increase the next day. *Advance one level during your next rehabilitation session or as instructed by healthcare professional. Once you have progressed through all of the strength levels and can maintain a score of 4 for two weeks. You can begin your return to climbing program in Phase 4.

 

*When advancing exercises to the next rehabilitation level or phase, make sure to continue to perform all exercises in previous rehabilitation levels or phases. For example. Once you have progressed into strength  level 2, make sure to continue to perform mobility exercise level 1,2,3 and strength exercise level 1.

Warm-up and Light Climbing

Perform the following climbing specific warm-up and light climbing protocol up to 2 times per week prior to your rehabilitation session. If any of the positions are painful, modify by decreasing how far you reach and how much you weight your arms. With these modifications, try to complete the warm-up and light climbing with pain less than 3 out of 10.

Rules for Return to Light Climbing:

  • It is recommended at this stage that you boulder-traverse in a gym on easy holds, which is one of the safest ways to continue to climb while minimizing stress on your injury. Boulder-traversing achieves a foundation of muscular fitness that will prepare your body eventually for more intense training. You have the opportunity to avoid aggravating moves since you can choose your holds and you can reinforce proper movement patterns. The appropriate amount of time “light climbing” is specific to the individual.

How to determine the appropriate light climbing time:

  • Determine how many minutes you can boulder-traverse without getting pumped and how many minutes you can boulder-traverse with pain less than 3/10
  • Take the lowest of those two times, reduce it by 50% and use that amount of time to perform your “light climbing” routine. Build your endurance eventually up to 2 X 20-30 minutes.
  • Progress the time “light traversing” approximately 10 percent each session as long as there is no increase in pain/soreness.

An example of how to determine to proper light climbing time:

  • You can boulder-traverse 12 minutes before you have pain and 18 minutes before you are pumped. The 6 minute time is the lowest time. You take the 12 minutes and reduce it by 50% so that it equals 6 minutes. You then start with 6 minutes of boulder-traversing. The next session you increase your time by 10% so that you light traverse for 7 minutes.

The Program

Phase 1 Tissue Unload:

Perform the unload technique 30 minutes prior to your warm-up and light climbing. The technique is optional. However, it may assist with decreasing your soreness/pain levels. After your warm-up and light climbing, you can begin your rehabilitation program with mobility exercise level 1.
1. Decrease pain

2. Decrease inflammation

3. Decrease tissue damage

  • If you have constant soreness/pain greater than 3/10 that worsens with warm-up, light climbing or mobility exercise level 1. You performed the unloading technique for two weeks and resumed the warm-up, light climbing and mobility exercise level 1 and there was no decrease in your soreness/pain. You need to stop the rehabilitation program and consult your medical professional.
  • If you do not feel a decrease in soreness/pain after 3 sessions of using the unload technique
  • If you have been using the unload technique for greater than 6 weeks, it is advised that you decrease the frequency of use and eventually discontinue using. This will decreases your reliance on the technique.

Phase 2 Mobility:

Begin with mobility exercise level 1. Use the rehabilitation guidelines to determine when to progress to the next mobility exercise level. 
1. Promote healing of the injured area

2. Increase circulation

3. Restore normal range of motion

  • If you have intermittent soreness/pain less than 3/10 that does not change while performing warm-up, light climbing or rehabilitation exercises and does not increase the next day –> advance to the next level of exercise at a rate of one level each week or as instructed by healthcare professional.
  • If you have intermittent soreness/pain less than 3/10 that improves while performing warm-up, light climbing or rehabilitation exercises and does not increase the next day –> advance to the next level of exercise at a rate of one level each session or as instructed by healthcare professional.
  • If you have intermittent soreness/pain less than 3/10 that does not change while performing warm-up, light climbing or rehabilitation exercises but increases the next day –> you should perform the unloading technique as needed and stay at current level.
  • If you have constant soreness/pain greater than 3/10 that worsens with warm-up, light climbing or mobility exercise level 1.
  • If you have numbness or tingling down your arm into your fingers
  • If you are woken up at night by pain
  • If you have taken two weeks off of exercises, have performed unloading techniques and your pain is still greater than 3/10 when you are resting.

Phase 3 Strength:

Start with strength exercise level 1 only after you have completed all three mobility exercises based on the rehabilitation guidelines. Follow the rehabilitation guidelines to determine when to progress to the next strength exercise level.
  1. Improve neuromuscular control
  2. Improve isolated strength
  3. Improve functional strength
  • If you have intermittent soreness/pain less than 3/10 that does not change while performing warm-up, light climbing or rehabilitation exercises and does not increase the next day –> advance to the next level of exercise at a rate of one level each week or as instructed by healthcare professional.
  • If you have intermittent soreness/pain less than 3/10 that improves while performing warm-up, light climbing or rehabilitation exercises and does not increase the next day –> advance to the next level of exercise at a rate of one level each session or as instructed by healthcare professional
  • If you have intermittent soreness/pain less than 3/10 that does not change while performing warm-up, light climbing or rehabilitation exercises but increases the next day –> you should perform the unloading technique as needed and stay at current level.
  • If you have constant soreness/pain greater than 3/10 that worsens with warm-up, light climbing or mobility exercise level 1.
  • If you have numbness or tingling down your arm into your fingers
  • If you are woken up at night by pain
  • If you have taken two weeks off of exercises, have performed unloading techniques and your pain is still greater than 3/10 when you are resting.

Phase 4 Movement:

Begin this process of transitioning from light climbing to more aggressive climbing once you have completed all three mobility and strength levels based on the rehabilitation guidelines. 
1. Reinforce proper movement patterns

2. Initiate from boulder-traversing back to higher level climbing

3. Promote concept of performing the rehabilitation program as an injury prevention program twice a week.

Still perform your boulder-traverse and climbing specific warm-up. Now it is time to begin to boulder and route climb. You should be increasing the difficulty and duration of your climbing sessions each by approximately 10% per week. For example: If you have been climbing routes up to V5 for 100 minutes with pain/soreness less than 3/10, then increase to V5+ and 110 minutes. Apply the below rule to your progression:

  • If you have intermittent soreness/pain less than 3/10 that improves while performing warm-up, light climbing, rehabilitation exercises and harder climbing and does not increase the next day –> increase your difficulty and duration by 10% that week.
Still perform your boulder-traverse and climbing specific warm-up. Now it is time to begin to boulder and route climb. You should be increasing the difficulty and duration of your climbing sessions each by approximately 10% per week. For example: If you have been climbing routes up to V5 for 100 minutes with pain/soreness less than 3/10, then increase to V5+ and 110 minutes. Apply the below rule to your progression:

  • If you have intermittent soreness/pain less than 3/10 that does not change while performing warm-up, light climbing, rehabilitation exercises and harder climbing and does not increase the next day –> increase your difficulty and duration by 10% that week.
Still perform your boulder-traverse and climbing specific warm-up. Now it is time to begin to boulder and route climb. You should be increasing the difficulty and duration of your climbing sessions each by approximately 10% per week. For example: If you have been climbing routes up to V5 for 100 minutes with pain/soreness less than 3/10, then increase to V5+ and 110 minutes. Apply the below rule to your progression:

  • If you have intermittent soreness/pain less than 3/10 that does not change while performing warm-up, light climbing, rehabilitation exercises and harder climbing but increases the next day –> you should decrease the difficulty and duration of your next climbing session by approximately 10%.